Patient characteristics of the Accident and Emergency Department of Kenyatta National Hospital, Nairobi, Kenya: a cross-sectional, prospective analysis

Abstract

BackgroundResource-limited settings are increasingly experiencing a ‘triple burden’ of disease, composed of trauma, non-communicable diseases (NCDs) and known communicable disease patterns. However, the epidemiology of acute and emergency care is not well characterised and this limits efforts to further develop emergency care capacity.ObjectiveTo define the burden of disease by describing the patient population presenting to the Accident and Emergency Department (A&E) at Kenyatta National Hospital (KNH) in Kenya.MethodsWe completed a prospective descriptive assessment of patients in KNH’s A&E obtained via systematic sampling over 3 months. Research assistants collected data directly from patients and their charts. Chief complaint and diagnosis codes were grouped for analysis. Patient demographic characteristics were described using the mean and SD for age and n and percentages for categorical variables. International Classification of Disease 10 codes were categorised by 2013 Global Burden of Disease Study methods.ResultsData were collected prospectively on 402 patients with an average age of 36 years (SD 19), and of whom, 50% were female. Patients were most likely to arrive by taxi or bus (39%), walking (28%) or ambulance (17%). Thirty-five per cent of patients were diagnosed with NCDs, 24% with injuries and 16% with communicable diseases, maternal and neonatal conditions. Overall, head injury was the single most common final diagnosis and occurred in 32 (8%) patients. The most common patient-reported mechanism for head injury was road traffic accident (39%).ConclusionThis study estimates the characteristics of the A&E population at a tertiary centre in Kenya and highlights the triple burden of disease. Our findings emphasise the need for further development of emergency care resources and training to better address patient needs in resource-limited settings, such as KNH.

Clinical and Financial Implications of Medicine Consumption Patterns at a Leading Referral Hospital in Kenya to Guide Future Planning of Care

“…Injuries including burns are still the third most common cause of morbidity and mortality in Kenya, and a leading cause of death in other LMICs (WHO, 2017a). This is consistent with our data and other reports showing that KNH, being a public referral hospital, handles the majority of patients with severe injuries and burns in Kenya (Botchey et al, 2017; Myers et al, 2017). These conditions require long term costly treatment; consequently, most poor patients are referred to KNH where a single ward can incorporate as many as 100 patients.…”

Presenting complaints and mortality in a cohort of 22 000 adult emergency patients at a local hospital in Nepal

“…Our study is in line with a systematic review in LMICs [6] and studies from Nepal [26] and Cambodia [27], showing that the majority of emergency patients are young adults. Injury was the main presenting complaint followed by abdominal complaints and infections, similar to reports from other LMICs [28,29].…”

Impact of endemic HIV on emergency care service delivery in South Africa

“…These are similar to those reported in other studies examining chief complaints in Africa. [20,21] In the present study, assault-related chief complaints (stab wounds/cuts and bluntforce injuries) appeared twice in the top five overall complaints for HIV-negative patients,…”